Healthcare Provider Details

I. General information

NPI: 1346314150
Provider Name (Legal Business Name): ELTON DEVIN SAVAGE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EDGEWOOD DR
GRANVILLE OH
43023-1076
US

IV. Provider business mailing address

134 1/2 BROADWAY E
GRANVILLE OH
43023-1304
US

V. Phone/Fax

Practice location:
  • Phone: 740-920-4124
  • Fax:
Mailing address:
  • Phone: 740-920-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: